EP2429377B1 - Instrument médical - Google Patents

Instrument médical Download PDF

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Publication number
EP2429377B1
EP2429377B1 EP10720748.2A EP10720748A EP2429377B1 EP 2429377 B1 EP2429377 B1 EP 2429377B1 EP 10720748 A EP10720748 A EP 10720748A EP 2429377 B1 EP2429377 B1 EP 2429377B1
Authority
EP
European Patent Office
Prior art keywords
cylinder
hydraulic
end effector
medical instrument
piston
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Active
Application number
EP10720748.2A
Other languages
German (de)
English (en)
Other versions
EP2429377A1 (fr
Inventor
Johann Klaffenböck
Lukas Klaffenböck
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
KLAFFENBOECK, JOHANN
KLAFFENBOECK, LUKAS
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
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Publication of EP2429377A1 publication Critical patent/EP2429377A1/fr
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Publication of EP2429377B1 publication Critical patent/EP2429377B1/fr
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00539—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated hydraulically
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws

Definitions

  • the invention relates to a medical instrument having an elongated member, preferably configured for transoral placement in a stomach, and an end effector attachable to one end of the elongated member, the end effector being operable via a hydraulic actuating mechanism, and a method of actuating a End effector, which is arranged in particular at one end of an endoscopy system.
  • the hydraulic actuating mechanism comprises a cylinder having at least one, preferably two, three, four or five overflow channels for a hydraulic fluid, which are connected via at least one bore with the cylinder interior a piston arranged in the cylinder and movable along the longitudinal axis of the cylinder, wherein the piston divides the interior of the cylinder into a first cylinder space and into a second cylinder space and communicates with the end effector via a piston rod, and at least one connection to Introduction of hydraulic fluid in the first cylinder chamber and at least one further connection, which communicates with at least one overflow channel of the cylinder, are provided.
  • the overflow channels are in this case formed in a first embodiment of the invention as depressions on the outer surface of the cylinder wall and are connected via bores with the interior of the cylinder, wherein the bores have a different distance to one end of the cylinder.
  • the cylinder is preferably used in a sleeve, so that the overflow between the sleeve inner wall and the cylinder outer wall are formed by the recesses in the cylinder outer wall.
  • connections for the hydraulic fluid in communication with the interior of the cylinder are arranged in a sealing element which is arranged on the end of the sleeve facing away from the piston rod in order to obtain a compact and reliable hydraulic actuating mechanism.
  • the at least one overflow channel is arranged within the cylinder wall and communicates via at least one bore with the cylinder chamber.
  • an end effector with two gripping elements for use in gastric replication requires three operating states: a first closed position in which the end effector is placed, for example, in the stomach of a patient; an open position, from which by movement of the gripping elements tissue is arranged between the gripping elements and finally a second closed position in which a stapling device sewn between the gripping elements of the end effector tissue.
  • An end effector which can be used for this purpose can be, for example, the EP 1 187 559 A1 or the US 2004/59349 A1 be removed.
  • end effectors can be connected to the medical instrument according to the invention, for which purpose a standardized adapter element is preferably provided on the medical instrument.
  • a standardized adapter element is preferably provided on the medical instrument.
  • end effectors a wide variety of gripping elements, but also probes and other endoscopic and / or endosurgical elements can be connected to the hydraulic system according to the invention.
  • the hydraulic actuating mechanism For operating the hydraulic actuating mechanism according to the invention is preferably a hydraulic device which cooperates with the hydraulic actuating mechanism provided, wherein the hydraulic device comprises at least one pump and at least one hydraulic line to each connection of the sealing element, and preferably each hydraulic line is assigned at least one switching element.
  • an endosurgical instrument in particular an endoscope, having an elongated element, which is preferably configured for transoral placement in a stomach, and an end effector disposed at one end of the elongate element, the end effector being over the Device according to the invention is hydraulically actuated.
  • the end effector preferably has two claw-like gripper elements, which are movable from an open position into at least one closed position, preferably two closed positions or even more to one another.
  • the position of a piston with a piston rod within a cylinder by inflow of hydraulic fluid into a first cylinder chamber and / or by outflow of Hydraulic fluid changed from a second cylinder chamber of the cylinder, wherein the piston position determines the operating state of the associated with the piston rod end effector.
  • the medical instrument according to the invention can also be used in conjunction with known endoscopic system.
  • the diameter of the medical instrument according to the invention can be kept so low that it can be arranged for example in a channel of an endoscope according to the prior art.
  • Fig. 1 is shown in an exploded view of the hydraulic actuating mechanism 1 according to the invention in particular for an endosurgical and / or endoscopic instrument. It has a sleeve 10 into which a cylinder 20 can be inserted.
  • the cylinder 20 has in the illustrated embodiment, four overflow channels 21a, 21b, 21c, 21d, which are formed as parallel to the longitudinal axis A of the cylinder 20 milled recesses on the outer surface of the cylinder 20 and with the interior 23 (FIGS. Figs. 2a, 2b ) of the cylinder 20 through holes 22a, 22b, 22b ', 22c, 22c', 22d, 22d 'are in communication.
  • the hydraulic actuating mechanism 1 has a piston 30 with a piston rod 31 and a sealing piston skirt 32 which is movable in the cylinder 20 along its longitudinal axis A.
  • a sealing element 40 is provided which has five ports 41, 41a, 41b, 41c, 41d designed as bores for the hydraulic fluid line through the sealing element 40.
  • the hydraulic actuating mechanism 1 is shown in the assembled state.
  • the cylinder 20 is disposed in the sleeve 10 and fixed by means of sealing element 40 in its position.
  • the arrangement of sleeve 10, cylinder 20 and sealing element 40 is made such that the hydraulic connections 41a, 41b, 41c, 41d of the sealing element 40 are arranged in alignment with the overflow channels 21a, 21b, 21c, 21d of the cylinder 20, the overflow channels 21a, 21b, 21c, 21d via holes 22a, 22b, 22b ', 22c, 22c', 22d, 22d 'are in communication with the interior of the cylinder 20.
  • the piston 30 is arranged in the interior of the cylinder 20, wherein the piston rod 31 is guided through a central opening 11 of the sleeve 10.
  • the piston 30 has at its arranged inside the cylinder 20 piston skirt 32 sealing means 33 which surround the piston skirt 32 annular and close in corresponding position of the piston 30 within the interior 23 of the cylinder 20 at least one overflow 21a, 21b, 21c, 21d Fig. 2a ).
  • Another sealing means 13 is provided in the concentric opening 11 of the sleeve 10 to prevent leakage of hydraulic fluid from the cylinder 20.
  • Fig. 3 is a plan view of the hydraulic actuating mechanism 1, in which substantially the sealing element 40 is visible. It can be seen here that four further connections 41a, 41b, 41c, 41d are arranged on the substantially square sealing plate 40 around a central hydraulic connection 41. In the corners of the sealing plate 40 are further recesses 42, which serve to receive fixing elements (not shown) for fixing the sealing plate 40 to the sleeve 10, are provided. In the Fig. 2d Finally, a plan view of the hydraulic actuating mechanism 1 according to the invention is shown, in which case consideration is given to the piston rod 31.
  • Fig. 3a to Fig. 3c is the actuating mechanism 1 with attached end effector 100, as it comes in particular in endosurgical procedures used.
  • the end effector 100 is disposed on the piston rod 31 of the piston 30, wherein the end effector 100 as shown in the Fig. 3b shown in an open position.
  • the end effector 100 has two claw-like gripping elements 110a, 110b, wherein in the one gripping element 110a a first part 120a of a clamping element is arranged, which has two pins 121 which are arranged on a plate element 122a.
  • Such a stapling device can be found for example in the Austrian patent application A 239/2009 of the applicant.
  • the first part 120a of the stapling device is engaged with a second part 122b of the stapler arranged in the second gripping element 110b, for example to fix tissue in the course of gastric replication .
  • guide elements 111a, 111b are provided, which are moved along guide grooves 112a, 112b when the piston 30 of the hydraulic actuating mechanism 1 moves.
  • Fig. 3a is the piston 30 at its lowermost position, in which it bears substantially against the sealing plate 40, shown.
  • the guide elements 111a, 111b are moved along the guide grooves 112a in the direction of the gripping elements 110a, 110b, so that in succession due to the position of the guide grooves 112a, 112b move towards each other.
  • the curved position of the guide grooves 112a, 112b has the advantage that a small force is required for a first closing of the end effector 100, while in the second closed position the force required for breaking off the pins 121 higher force due to the special position of the guide grooves 112a, 112b is delivered.
  • the guide grooves 112a, 112b can be made running straight or curved depending on the application.
  • the hydraulic device 200 has a pump 201, with the aid of which hydraulic fluid is supplied to the hydraulic actuating mechanism 1 via a first hydraulic line 202, which communicates with a first cylinder chamber 23a. Furthermore, the overflow channels 21a, 21b, 21c, 21d are connected to further hydraulic lines 202a, 202b, 202c, 202d and communicate with a reservoir 203 for hydraulic fluid.
  • Each hydraulic line 202, 202a, 202b, 202c, 202d is equipped with at least one switching element 204, for example a hydraulic valve, which allows a switching and thus a flow of the hydraulic fluid in the respective hydraulic line 202, 202a, 202b, 202c, 202d.
  • switching element 204 for example a hydraulic valve, which allows a switching and thus a flow of the hydraulic fluid in the respective hydraulic line 202, 202a, 202b, 202c, 202d.
  • an additional return element 210 is advantageous in the FIGS. 8a and 8b is described in detail.
  • Fig. 12 shows the circuit in which the piston 30 of the hydraulic actuating mechanism 1 is shown in its lowermost position in close proximity to the sealing plate 40.
  • the hydraulic lines 202, 202a, 202b, 202c, 202d are shown directly in a position on the overflow channels 21, 21a, 21b, while in the embodiment of the invention according to FIGS Figs. 1 to 2d the hydraulic lines 202, 202a, 202b, 202c, 202d are actually connected to the sealing element 40.
  • FIG. 4a shows the state of the hydraulic device 200, in which the end effector 100 is opened, as shown in the Fig. 3a to Fig. 3c respectively.
  • Fig. 4b is shown.
  • the end effector 100 according to the Fig. 3a with the associated cover 101, for example, made of silicone.
  • the hydraulic actuating mechanism 1 is particularly suitable for the operation of end effectors used in endoscopic gastric replication.
  • endoscopic gastric plication an end effector 100 is inserted into the stomach with the aid of an endoscope and subsequently actuated in such a way that a stapling device arranged in the end effector 100 (such as, for example, those in US Pat Fig. 3a to Fig. 3c shown) in the (stomach) tissue is placed.
  • a stapling device arranged in the end effector 100 such as, for example, those in US Pat Fig. 3a to Fig. 3c shown
  • the end effector 100 must be closed so as not to injure the esophagus or stomach during insertion.
  • the end effector 100 must not be closed so far that the pins 121 of the stapler engage in the second plate-shaped part 122b.
  • Fig. 5a to Fig. 5c is the first closed position of the end effector 100, in which the preferred transoral placement of the end effector 100 takes place at the desired location, shown with associated hydraulic scheme.
  • the piston 30 is located within the cylinder 20 in a central position and divides the interior of the cylinder into two cylinder chambers 23 a and 23 b.
  • the two grasping elements 110a, 110b move to the open position according to FIG Fig. 4b emotional.
  • the stomach tissue is gripped by the gripping members 110a, 110b and pierced by the pins 121.
  • the piston 30 is in an uppermost position according to Fig. 6a to 6c brought in which the pins 121 of the stapler break at the intended breaking point (not shown).
  • the end effector 100 is reopened by moving the piston 30 to the lowermost position in the immediate vicinity of the sealing element 40 ( Fig. 6d ), wherein the hydraulic fluid flows via the overflow passage 202 d in the second cylinder chamber 23 b, the stapling device remains in the tissue and the end effector 100 can turn in the first closed position according to the Fig. 5b and Fig. 5c be removed from the stomach by pulling it over the esophagus as well as the oral cavity.
  • hydraulic actuating mechanism 1 is not only suitable for the illustrated end effector 100, but can also be used for other end-effectors, in particular those used in medicine be operated via Bowden cables, push or pull elements are used.
  • forceps-like end-effectors 100 are also operated with the actuating mechanism 1 according to the invention.
  • the hydraulic unit 200 as in Fig. 7c illustrated, easier to do, because here only two positions, namely an open position and a closed position of the end effector 100 must be controlled. Therefore, in this embodiment, the hydraulic actuating mechanism 1 has only one overflow channel 21, while the sealing plate 40 has a hydraulic connection 41 for the pressure build-up in the interior 23 of the cylinder 20 and a hydraulic connection 41 a, which communicates with the overflow channel 21.
  • the hydraulic actuating mechanism described above can also be used with more than one overflow channel.
  • the return element 210 in this case has a spring device 211, here a spring, as well as a rotary knob 212, by means of which the desired spring force can be adjusted. Via a sealing plate 240 with a hydraulic connection 241, the return element 210 is connected to the hydraulic system and, if necessary, can be connected via the switching element 214 (FIG. Fig. 7c ) to be activated. It is understood that this return element can also be used in conjunction with other end effectors of all kinds.
  • a signaling device may be provided which indicates a pressure drop within the hydraulic system 200, after which the restoring element 210 can be activated by the user.
  • the invention is not limited to the illustrated embodiments.
  • the number and position of the overflow can be adapted to the respective requirements, it can also be provided more than five transfer channels.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Physics & Mathematics (AREA)
  • Biophysics (AREA)
  • Optics & Photonics (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Surgical Instruments (AREA)

Claims (8)

  1. Instrument médical comportant un élément longitudinal ainsi qu'un effecteur terminal (100) pouvant être monté à une extrémité de l'élément longitudinal, cet effecteur terminal (100) pouvant être actionné par un mécanisme d'actionnement hydraulique (1),
    caractérisé en ce que
    le mécanisme d'actionnement hydraulique (1) comporte un cylindre (20) équipé d'au moins un et de préférence de deux, trois, quatre ou cinq canaux de passage (21a, 21b, 21c, 21d) d'un fluide hydraulique qui sont reliés à la partie interne du cylindre par au moins un perçage (22a, 22b, 22b', 22c, 22c', 22d, 22d'), un piston (30) monté dans le cylindre (20) et mobile le long de l'axe longitudinal du cylindre (20) est prévu, ce piston (30) subdivisant la partie interne (23) du cylindre (20) en une première chambre de cylindre (23a) et une seconde chambre de cylindre (23b), et étant relié à l'effecteur terminal (100), par l'intermédiaire d'une tige de piston (31) et, il est prévu au moins un élément de liaison (41) pour permettre l'introduction de fluide hydraulique dans la première chambre de cylindre (23a) ainsi qu'au moins un autre élément de liaison (41a, 41 b, 41c, 41d) qui est relié à au moins un canal de passage (21a, 21 b, 21c, 21d) du cylindre (20).
  2. Instrument médical conforme à la revendication 1,
    caractérisé en ce que
    le perçage (22a, 22b, 22b', 22c, 22c', 22d, 22d') d'au moins un canal de passage (21a, 21 b, 21c, 2 1 d) est monté entre une butée de piston supérieure et une butée de piston inférieure de sorte que le piston (30) puisse être positionné dans le cylindre (20) dans au moins une position médiane définie qui est située entre la butée de piston supérieure et la butée de piston inférieure.
  3. Instrument médical conforme à la revendication 1 ou 2,
    caractérisé en ce que
    le canal de passage (21a, 21 b, 21c, 21d) est réalisé sur la surface externe du cylindre (20) sous la forme d'un évidement et est relié à la chambre de cylindre (23a, 23b), par l'intermédiaire du perçage (22a, 22b, 22b', 22c, 22c', 22d, 22d') le cylindre (20) pouvant être logé dans une douille (10).
  4. Instrument médical conforme à la revendication 3,
    caractérisé en ce que
    les éléments de liaison (41, 41a, 41b, 41c, 41d) pour le fluide hydraulique reliés à la partie interne (23) du cylindre (20) sont montés dans un élément d'étanchéité (40) qui est monté à l'extrémité de la douille (10) située à l'opposé de la tige de piston (31).
  5. Instrument médical conforme à la revendication 1 ou 2,
    caractérisé en ce que
    le canal de passage (21a, 21 b, 21c, 21d) est monté dans la paroi du cylindre et est relié à la partie interne du cylindre (23a, 23b) pour l'intermédiaire d'au moins un perçage (22a, 22b, 22b', 22c, 22c', 22d, 22d').
  6. Instrument médical conforme à l'une des revendications 1 à 5,
    caractérisé en ce que
    pour chaque canal de passage (21a, 21 b, 21c, 21d) il est prévu deux perçages (22a, 22b, 22b', 22c, 22c', 22d, 22d').
  7. Instrument médical conforme à l'une des revendications 1 à 6,
    caractérisé en ce que
    l'effecteur terminal (100) comporte deux éléments de préhension en forme de griffes (100a, 110b) qui peuvent être déplacés à partir d'une position ouverte dans au moins une position fermée et de préférence dans deux positions fermées.
  8. Instrument médical conforme à l'une des revendications 1 à 7,
    caractérisé en ce qu'
    il est prévu un dispositif d'actionnement de l'effecteur terminal de cet instrument médical avec un dispositif hydraulique (200) qui coopère avec le mécanisme d'actionnement hydraulique (1) de l'instrument médical, le dispositif hydraulique (200) comportant au moins une pompe (201) aussi qu'au moins une conduite hydraulique respective (202, 202a, 202b, 202c, 202d) s'étendant jusqu'à chaque élément de liaison (41, 41a, 41b, 41c, 41d) de l'élément d'étanchéité (40), et de préférence à chaque conduite (202, 202a, 202b, 202c, 202d) est associé au moins un élément de commutation (204).
EP10720748.2A 2009-05-15 2010-05-14 Instrument médical Active EP2429377B1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
AT0076409A AT507563B1 (de) 2009-05-15 2009-05-15 Vorrichtung zur betätigung eines endeffektors
PCT/EP2010/056656 WO2010130829A1 (fr) 2009-05-15 2010-05-14 Instrument médical

Publications (2)

Publication Number Publication Date
EP2429377A1 EP2429377A1 (fr) 2012-03-21
EP2429377B1 true EP2429377B1 (fr) 2014-03-19

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
EP10720748.2A Active EP2429377B1 (fr) 2009-05-15 2010-05-14 Instrument médical

Country Status (8)

Country Link
US (1) US8828048B2 (fr)
EP (1) EP2429377B1 (fr)
JP (1) JP5582509B2 (fr)
KR (1) KR101489417B1 (fr)
CN (1) CN102438500B (fr)
AT (1) AT507563B1 (fr)
CA (1) CA2761869C (fr)
WO (1) WO2010130829A1 (fr)

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AT518032B1 (de) * 2015-11-20 2017-11-15 Johann Klaffenböck Mag Medizinisches instrument
US11199545B2 (en) * 2017-01-31 2021-12-14 Asensus Surgical Us, Inc. Hydraulic instrument drive system for minimally invasive surgery
CN108175511A (zh) * 2018-02-26 2018-06-19 路要武 一种单孔腹腔镜机器人系统
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Also Published As

Publication number Publication date
AT507563B1 (de) 2010-06-15
US20120101483A1 (en) 2012-04-26
AT507563A4 (de) 2010-06-15
CN102438500B (zh) 2014-11-05
JP2012526576A (ja) 2012-11-01
WO2010130829A1 (fr) 2010-11-18
KR20120030088A (ko) 2012-03-27
EP2429377A1 (fr) 2012-03-21
CN102438500A (zh) 2012-05-02
JP5582509B2 (ja) 2014-09-03
US8828048B2 (en) 2014-09-09
KR101489417B1 (ko) 2015-02-04
CA2761869C (fr) 2015-11-24
CA2761869A1 (fr) 2010-11-18

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